Our NHS: a place for ethical consumption?

by Catherine WillMar 15, 2013

Photo: Single Slice from pernillarydmark Flickr photostream

Two weeks ago the news covered a tragic death: a seven week old baby, Axel, succumbed to a chest infection despite repeated contact with the health services. The story gained traction not so much as a narrative of professional mistakes, but of the possible failings of commercial providers, amidst ongoing debates about the extent to which care should be opened up to competitive tendering.

As reported in the Guardian, the baby’s parents made the link to the politics of healthcare quite explicit (not least through adding their voice to the 38 Degrees petition against privatisation and cuts in the NHS). Though the coroner focussed her criticism on only one of the doctors working for Harmoni – a privatised out of hours GP service – not the company as a whole, Axel’s father was quoted as saying:

‘I have reservations about the way some of the doctors who treated us performed, but the root causes of what went wrong are way above them. I know the NHS is hugely put upon by rising population, but the answer is not to apply normal commercial practice to the health service, so that people are looking at the bottom line.’

In contrast, the Guardian described the parents as ‘socially considerate’ through their efforts to make modest use of the NHS. As Axel’s mother put it, ‘As a family we thought we were accessing health services through the appropriate route and that they would know when to refer to A&E.’

Such quotes offer an interesting example of ‘ethical consumption’ of healthcare identified by Ruth McDonald and colleagues at the University of Manchester in a paper published in the journal Sociology of Health and Illness. They reported that users of general practice, interviewed as part of a broader research project, were at pains to describe careful use of scarce health resources.

‘I would only go to the doctor’s if I felt really bad, if I was in physical pain. I wouldn’t go to the doctor with a cold.’

‘I don’t go that often if I can help it, only if I need to go.’

McDonald and her co-authors describe these as efforts to by their interviewees to present themselves as aware of other people’s need for a limited resource. After Axel’s death we might wonder how often it leads to poor care. But the story also raises other questions about such ‘ethical consumption’ of healthcare now and in the future. We don’t know how widespread this idea might be, nor how far it affects when and how different kinds of people use the NHS. To the extent that it does shape the use of health care in the UK today, we need to ask about the effects of the current policies. Will people become less ‘socially considerate’ if more providers are making profits? Will the intended local flavour of clinical commissioning reduce or increase our awareness of other people’s needs for healthcare? In education – another collective good – such social framing appears to have limited appeal already, and ethical consumption seems fraught with ambivalence and anxiety. Are we going to see fewer ‘ethical consumers’ and more demanding customers in the NHS that results from current policy?